NR 547 Final Exam 2025/2026 Test Bank | 50
Differential Diagnosis Questions & Answers |
PMHNP Exam Prep | Chamberlain College of
Nursing | Psychiatric–Mental Health Guide
Q1. A 32-year-old presents with 3 weeks of pervasive low
mood, anhedonia, hypersomnia, increased appetite, and
excessive guilt following a breakup. She reports passive
thoughts that life is “not worth it” but denies intent or plan.
Which diagnosis best fits?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with depressed mood
D. Bipolar II disorder, current depressive episode
Correct Answer: C
Rationale: The temporal relationship (symptoms beginning after
a psychosocial stressor) and relatively short duration (3 weeks)
with impairment points to Adjustment Disorder; MDD requires
≥2 weeks but the context and presence of stressor-focused
onset favor adjustment disorder over MDD or dysthymia;
Bipolar II would require history of hypomania.
,Q2. A 28-year-old reports 2 months of excessive worry about
work and family, difficulty concentrating, muscle tension, and
restlessness occurring most days. Which feature best
differentiates Generalized Anxiety Disorder (GAD) from a
normal stress reaction?
A. Presence of a precipitating stressor
B. Worry is difficult to control and causes significant impairment
C. Symptoms resolve with time without intervention
D. Worry limited to a single domain (e.g., work)
Correct Answer: B
Rationale: GAD is characterized by excessive, difficult-to-control
worry across multiple domains with associated physiological
symptoms and functional impairment for ≥6 months (DSM-5-
TR); difficulty controlling the worry and impairment
differentiates pathological GAD from normative stress.
Q3. A 45-year-old with long-standing insomnia, nightmares,
hypervigilance, and avoidance of places reminiscent of a motor
vehicle collision that occurred 5 months ago most likely meets
criteria for:
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Specific phobia
,Correct Answer: B
Rationale: PTSD diagnosis requires symptoms persisting >1
month after trauma, including intrusion (nightmares),
avoidance, negative alterations in cognition/mood, and
hyperarousal; acute stress disorder is <1 month.
Q4. A 19-year-old college student reports hearing a continuous
voice commenting on his actions, with no impairment of
consciousness. Onset was gradual over 6 months with social
withdrawal and decline in grades. Best diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Major depressive disorder with psychotic features
Correct Answer: A
Rationale: Schizophrenia requires ≥6 months of characteristic
symptoms (including hallucinations, negative symptoms like
social withdrawal) with decline in functioning; brief psychotic
disorder is <1 month; schizoaffective requires a mood episode
with psychosis of sufficient duration.
Q5. An 80-year-old with progressive memory impairment for 18
months exhibits fluctuating attention, visual hallucinations, and
parkinsonism. Which diagnosis is most likely?
, A. Alzheimer’s disease
B. Dementia with Lewy bodies (DLB)
C. Vascular neurocognitive disorder
D. Major depressive disorder, pseudodementia
Correct Answer: B
Rationale: DLB is suggested by progressive cognitive decline
with pronounced fluctuations, visual hallucinations, and
parkinsonian features; Alzheimer’s typically presents with
memory predominant decline without early visual
hallucinations and parkinsonism.
Q6. A 10-year-old presents with inattentiveness at school, fails
to follow instructions, and shows symptoms across school and
home for 9 months. Which additional feature is required to
diagnose ADHD (predominantly inattentive type) per DSM-5-
TR?
A. Onset before age 18
B. Presence of hyperactivity
C. Improvement with stimulant medication
D. Symptoms limited to one environment
Correct Answer: A
Rationale: DSM-5-TR requires several symptoms present before
age 12 (note: DSM-5-TR wording may specify childhood onset),
symptoms in two or more settings, and impairment;
Differential Diagnosis Questions & Answers |
PMHNP Exam Prep | Chamberlain College of
Nursing | Psychiatric–Mental Health Guide
Q1. A 32-year-old presents with 3 weeks of pervasive low
mood, anhedonia, hypersomnia, increased appetite, and
excessive guilt following a breakup. She reports passive
thoughts that life is “not worth it” but denies intent or plan.
Which diagnosis best fits?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with depressed mood
D. Bipolar II disorder, current depressive episode
Correct Answer: C
Rationale: The temporal relationship (symptoms beginning after
a psychosocial stressor) and relatively short duration (3 weeks)
with impairment points to Adjustment Disorder; MDD requires
≥2 weeks but the context and presence of stressor-focused
onset favor adjustment disorder over MDD or dysthymia;
Bipolar II would require history of hypomania.
,Q2. A 28-year-old reports 2 months of excessive worry about
work and family, difficulty concentrating, muscle tension, and
restlessness occurring most days. Which feature best
differentiates Generalized Anxiety Disorder (GAD) from a
normal stress reaction?
A. Presence of a precipitating stressor
B. Worry is difficult to control and causes significant impairment
C. Symptoms resolve with time without intervention
D. Worry limited to a single domain (e.g., work)
Correct Answer: B
Rationale: GAD is characterized by excessive, difficult-to-control
worry across multiple domains with associated physiological
symptoms and functional impairment for ≥6 months (DSM-5-
TR); difficulty controlling the worry and impairment
differentiates pathological GAD from normative stress.
Q3. A 45-year-old with long-standing insomnia, nightmares,
hypervigilance, and avoidance of places reminiscent of a motor
vehicle collision that occurred 5 months ago most likely meets
criteria for:
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Specific phobia
,Correct Answer: B
Rationale: PTSD diagnosis requires symptoms persisting >1
month after trauma, including intrusion (nightmares),
avoidance, negative alterations in cognition/mood, and
hyperarousal; acute stress disorder is <1 month.
Q4. A 19-year-old college student reports hearing a continuous
voice commenting on his actions, with no impairment of
consciousness. Onset was gradual over 6 months with social
withdrawal and decline in grades. Best diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Major depressive disorder with psychotic features
Correct Answer: A
Rationale: Schizophrenia requires ≥6 months of characteristic
symptoms (including hallucinations, negative symptoms like
social withdrawal) with decline in functioning; brief psychotic
disorder is <1 month; schizoaffective requires a mood episode
with psychosis of sufficient duration.
Q5. An 80-year-old with progressive memory impairment for 18
months exhibits fluctuating attention, visual hallucinations, and
parkinsonism. Which diagnosis is most likely?
, A. Alzheimer’s disease
B. Dementia with Lewy bodies (DLB)
C. Vascular neurocognitive disorder
D. Major depressive disorder, pseudodementia
Correct Answer: B
Rationale: DLB is suggested by progressive cognitive decline
with pronounced fluctuations, visual hallucinations, and
parkinsonian features; Alzheimer’s typically presents with
memory predominant decline without early visual
hallucinations and parkinsonism.
Q6. A 10-year-old presents with inattentiveness at school, fails
to follow instructions, and shows symptoms across school and
home for 9 months. Which additional feature is required to
diagnose ADHD (predominantly inattentive type) per DSM-5-
TR?
A. Onset before age 18
B. Presence of hyperactivity
C. Improvement with stimulant medication
D. Symptoms limited to one environment
Correct Answer: A
Rationale: DSM-5-TR requires several symptoms present before
age 12 (note: DSM-5-TR wording may specify childhood onset),
symptoms in two or more settings, and impairment;
